Healthcare Provider Details

I. General information

NPI: 1699753343
Provider Name (Legal Business Name): RICHARD DARREN ALLEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E 13TH ST SUITE 102
GROVE OK
74344-2975
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE SUITE 280
OKLAHOMA CITY OK
73112-5556
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-7200
  • Fax: 918-786-7212
Mailing address:
  • Phone: 918-786-7200
  • Fax: 918-786-7212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number3647
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: